Mixed hearing loss is when a person has conductive hearing loss at the same time as sensorineural hearing loss.
On this page, you can find out all about these types of hearing loss and what they mean.
What is mixed hearing loss?
The definition of mixed hearing loss is that there are elements of both conductive and sensorineural hearing loss.
What does sensorineural hearing loss mean?
Sensorineural hearing loss means the inner ear or hearing nerve is damaged or unable to process sound as intended. This type of hearing loss can be genetic or acquired during a person’s life. It can affect people of all ages.
The inner ear and hearing nerve deliver a high-resolution signal to the brain for processing. When the inner ear is damaged, the sound's resolution reduces, making the sound not only quieter but less precise. It can also result in a decreased tolerance for louder sounds, making them uncomfortable.
You can learn more on our sensorineural hearing loss webpage.
What does conductive hearing loss mean?
Conductive hearing loss is when there is damage or an obstruction in the outer or middle ear. This prevents the sound waves from being effectively conducted from the outside world and into the inner ear.
There are different causes of conductive loss. These include a deformity in the ear’s anatomy, infection or disease, or damage to the outer ear or the bones (ossicles) in the middle ear, which prevent sound from being transmitted to the inner ear.
You can learn more about conductive hearing loss here.
The symptoms of mixed hearing loss
Since mixed hearing loss is a combination of sensorineural hearing loss and conductive hearing loss, the symptoms of mixed hearing loss are usually a mixture of the symptoms of each of the types of hearing loss.
If you experience any of the following symptoms, you should have your hearing tested by your hearing care specialist. Before you book an appointment, you can check your hearing with an online hearing test.
The symptoms of sensorineural hearing loss
If you have a sensorineural component to your hearing loss, you may experience one or more of the following symptoms:
- you have difficulty understanding or hearing speech when there is background noise (e.g., in a restaurant or café)
- you feel that people mumble, or that sounds are not sharp
- others complain that the TV is too loud
- you experience ringing in your ears (tinnitus)
- you often ask other people to repeat themselves
- you have trouble understanding others on the phone
- other people notice that you do not hear well.
For more information about the symptoms of sensorineural loss, visit our webpage about sensorineural hearing loss.
The symptoms of conductive hearing loss
If you have a conductive component to your hearing loss, you may experience one or more of the following symptoms:
- pain in either ear can indicate a problem and may cause hearing loss
- ears feel plugged or over-pressurized, and can’t be equalized. This can indicate a problem in the middle ear.
- muffled sounds that make it difficult to hear sounds around you
- liquid coming out of the ear, especially if it is yellow, green or pus coloured, or has a foul odor
- ringing sounds in your ears (tinnitus)
- your voice sounds louder and unusual to you
- your hearing is better in one ear.
For more information about conductive hearing loss, visit our webpage about conductive hearing loss.
Examples of mixed hearing loss
An example of mixed hearing loss is a person with a growth in the ear canal (causing a conductive hearing loss) and an underlying cause, which could be damage to the inner ear (causing a sensorineural hearing loss) caused by acoustic trauma.
What’s it like to have mixed hearing loss?
How much people with mixed hearing loss can hear depends on their level of hearing loss. Their hearing also depends on how much of the overall hearing loss is due to sensorineural hearing loss, and how much is due to conductive hearing loss in the outer or middle ear.
You can see more examples of what it feels like to have mixed hearing loss, on the webpages for each type of hearing loss.
Conductive hearing loss examples
Sensorineural hearing loss examples
Mixed hearing loss treatment
Mixed hearing loss is usually treated with hearing aids. Because there is mixed conductive and sensorineural hearing loss, the treatment needs to consider both of these elements. Treating mixed hearing loss can therefore require a combination of different approaches.
The conductive hearing loss element can often be treated through medical means, including physically removing problems such as impacted ear wax or objects in the ear canal, which block sound waves. If the conductive hearing loss is caused by infection, medicines such as antibiotics can be used to treat it.
In the case of physical abnormalities, tumors, or certain diseases, surgical procedures can repair the damage, such as patching holes in the eardrum or removing tumors or diseases such as cholesteatoma.
Implantable devices can also help with some types of conductive hearing loss resulting from middle ear damage. For disarticulated middle ear bones, there is a prosthesis called Total Ossicular Replacement Prosthesis (TORP). There are also bone-anchored hearing aids, which are implantable devices that can improve transmission loss.
The sensorineural portion of mixed hearing loss is treated with hearing aids. To learn more about the different hearing aids and options, see this article on hearing aids. Your hearing care specialist can help you select the best hearing aid treatment for you.
Implantable devices called cochlear implants can also be used to treat sensorineural hearing loss via a surgical intervention. Cochlear implants deliver sound to the ear by electrically stimulating the hearing nerve with tiny electrical impulses. This uses a small array implanted in the cochlea (inner ear organ) and a magnet surgically embedded in the skull behind the ear. There is also an external receiver and hearing device. This is an option for people with more significant hearing loss who receive little or no benefit from conventional hearing aids.
Causes of mixed hearing loss
Because mixed hearing loss is a combination of conductive and sensorineural hearing loss, there is always more than one individual cause of mixed hearing loss.
The causes of sensorineural hearing loss
Presbycusis or age-related hearing loss. This hearing loss occurs over time as we get older. Because the change happens gradually, it can take longer to recognize the hearing loss.
Noise-induced hearing loss. Noise can damage your ears. Depending on the level of sound and the length of time you experience it, it can cause temporary or permanent damage to your hearing. Some causes of noise-induced hearing loss include live concerts, listening to high volume levels with headphones, loud noises such as shooting, using power tools or equipment without hearing protection, motorcycling, snowmobiling, and working in noisy places such as construction sites and cafés.
Trauma. Head trauma or acoustic trauma can cause permanent hearing loss. Head trauma can come from any accident which involves a blow to the head (e.g., car accidents, bike accidents, falling, etc.). Acoustic trauma occurs due to an excessively loud sound, such as an explosion. The damage caused by acoustic trauma can include structural damage to the inner ear and noise-induced hearing loss. Trauma can also cause mixed hearing loss if it affects the conduction of sound into the inner ear.
Sudden hearing loss. Sudden sensorineural hearing loss is a category of hearing loss defined by hearing loss that occurs from one moment to the next, such as waking up with hearing loss. There are some known causes of sudden hearing loss, including viral infection, trauma, or disease, but sometimes no reason can be found.
Health factors. Several health factors can increase the likelihood of acquiring hearing loss. These factors include diabetes, obesity, smoking, or high blood pressure. A combination of these factors can cause both conductive and sensorineural hearing loss at the same time, which constitutes a mixed hearing loss.
Genetic disorders. Many disorders can have sensorineural hearing loss as part of the disorder (e.g., Waardenburg syndrome, Usher syndrome).
Hereditary factors. Hearing loss can be hereditary. It is a good idea to monitor your hearing if you have a family history of hearing loss.
Congenital disorders. Congenital means that something is present at birth. Babies can be born with genetic, hereditary, or other medically related causes of hearing loss such as ear malformations. Such disorders can also cause mixed hearing loss, where elements of both conductive and sensorineural hearing loss affect the person.
For more information, visit our webpage about sensorineural hearing loss.
The causes of conductive hearing loss
The causes of conductive hearing loss can be found in two areas: the outer ear and the middle ear. Because there are many different causes of conductive hearing loss, it can be permanent or temporary.
Blockage. Conductive hearing loss can result from something hindering the sound from reaching the middle ear. A blockage could consist of impacted ear wax or an object pushed into the canal. This type of conductive hearing loss may not be permanent. A blockage can combine with sensorineural hearing loss to cause mixed hearing loss.
Infection or disease. An infection can block the ear canal and cause conductive hearing loss. Common examples of this are swimmers’ ear and bony growths, called exostoses.
Disorders. Some people are born with an underdeveloped ear canal (atresia) that can cause conductive hearing loss. Other congenital disorders include an abnormal narrowing of the ear canal (stenosis), however, this can also be acquired later in life. Some other disorders which can lead to conductive hearing loss affect the outer ear. Such disorders can also cause mixed hearing loss, where elements of both conductive and sensorineural hearing loss affect the person.
Issues with the eardrum. When the eardrum's movements are hindered, conductive hearing loss can result. Causes include holes in the eardrum, thickening of the eardrum tissue, ear infections, or imbalances of pressure in the middle ear, with too much or too little pressure.
Fluid build-up. If fluid accumulates behind the eardrum, it can reduce the movement of the middle ear bones and prevent the eardrum from moving. Both problems can result in conductive hearing loss in the middle ear.
Middle ear bones. Any event that causes a disarticulation of these three bones can cause conductive hearing loss.
Disease or disorders. Middle ear diseases including benign tumors, otosclerosis, or cholesteatomas, can cause conductive hearing loss.
Eustachian tube dysfunction. The eustachian tube connects the middle ear to the back of the throat. It maintains a suitable pressure in the middle ear and allows any fluid to drain out if needed, by opening and closing – which is what makes your ears ‘pop’. If the eustachian tube is not working properly, pressure and fluid can build up in the middle ear, causing conductive hearing loss.
For more information, visit our webpage about conductive hearing loss.
Find out more about how mixed hearing loss occurs in this article about hearing loss.